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antibiotic question

charles krin cskrin2 at hughes.net
Thu Nov 17 16:52:35 GMT 2016


Errington:

Seven days out, repeat cultures negative, patient continues to improve? I'd
side with you that the week was enough.

Playing devil's advocate:

Any other risk factors for a subacute infection such as an endocarditis or
osteomylitis?

Are there any oral antibiotics that would kill *both* of the organisms?

https://www.ncbi.nlm.nih.gov/pubmed/21463773 covers length of treatment in
VAP associated with trauma, using culture results from Broncho-alveolar
lavage specimens.

The level of co morbidity and trauma probably preclude the use of
pro-calcitonin: http://cid.oxfordjournals.org/content/53/4/379.long

Most of the others I am finding are related to perioperative prophylactic
use - and you might recall that one of the base articles, at least for GYN
surgery, was done at LSU-Shreveport while you were there.

Chuck

-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org]
On Behalf Of Errington Thompson 
Sent: Thursday, November 17, 2016 9:03 AM
To: 'Trauma-List [TRAUMA.ORG]' <trauma-list at trauma.org>
Subject: antibiotic question

As usual, I'm in a relatively heated discussion over antibiotic therapy. 

 

67 yo male presents after a motor vehicle crash. The patient presents to the
emergency room hypotensive and hypoxic. The patient undergoes intubation.
Multiple CT scans reveal the patient to have a pulmonary contusion as well
as multiple rib fractures. The patient is morbidly obese and a central line
is placed. The patient is admitted to the intensive care unit. On hospital
day #5 the patient develops a fever as well as a elevated white blood cell
count. Cultures are taken from the central line as well as peripherally. The
patient was started on broad-spectrum antibiotics. The patient grows out
Serratia marcescens from both the central line and the peripheral blood
culture. The patient grows out Enterobacter from the sputum. The patient is
continued on piperacillin - tazobactam. The patient central line is removed.
Three days later the patient has two sets of peripheral blood cultures drawn
in these are negative. How long do you keep the patient on intravenous
antibiotics? Should the patient be switched over to PO antibiotics if the
patient can tolerate it? How long is total therapy?

My infectious disease colleague is arguing for 10 - 14 days of total
antibiotic therapy. I am not sure that that is necessary. After seven days
of therapy the patient is afebrile, the white blood cell count is normal.
What are your thoughts? What is the data (I really have not been able to
find any)?

 

Errington C. Thompson, MD, FACS, FCCM

Chief of Trauma Services

Marshall University

 <http://www.erringtonthompson.com/> Website

 

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